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Letters to the Editor

Indian Pediatrics 2005; 42:617-618

Psychogenic Diarrhea


We read with great interest recent communication by Bhatia, et al.(1). We greatly appreciate the conclusion drawn by the authors that psychogenic sneezing must be kept in mind in children to avoid unnecessary investigations. We were thus tempted to share our experience in a child with psychogenic diarrhea who responded to behavior therapy within one month.

An 8-year-old male child was brought by her anxious mother with complaints of increased frequency of stools from last 6 months especially after each meal. There was no history of any abdominal distension. The stools were semisolid in consistency but were not bulky or foul smelling. There was no blood or mucus. Physical and systemic examination was non-contributory. His anthropometric data were within normal centiles. Stool microscopy and pH were normal. Stool were also negative for reducing sugars. USG abdomen was also normal. A detailed history revealed other behavior problems in the child such as bruxism, tearing books and beating other classmates in school. He also during his OPD visits dismantled all the articles kept in the consultation chamber. History revealed the birth of his young brother about 15 months back after which all the attention of the mother has shifted away from him, resulting in sibling jealousy and resulting aggressive behavior as an expression of anger towards her mother. By defecating after each meal, he was able to draw the attention of her mother resulting in secondary gain and persistence of symptoms. The performance of the child in the school also deteriorated further aggravating the symptoms. The mother was counseled about the nature of illness, its onset and perpetuation. A meeting was held with teacher of his school who was also counseled with the problem in the child. He was treated with anxiolytic drugs, aversion therapy and reward on symptomatic improvement. His symptoms improved within a week and disappeared by 3rd week. He performed satisfactorily in yearly exams.

Non-organic recurrent abdominal pain (functional) is a common complaint in children(2). Irritable bowel syndrome is also a well-recognized entity in children presenting commonly as alteration of bowel habits(3). However, psychogenic diarrhea is un-commonly reported in children(4). Early anticipation of the condition and identification of the psychogenic stressor prevented us to evaluate chronic diarrhea beyond first phase investigations and early successful management of the case.

Pankaj Garg,
*Amit Abraham,

Shanti Mangalick Hospital and
*Department of Psychology,
St. John’s College,
Agra, U.P.
E-mail: [email protected]

References

1. Bhatia MS, Khandpal M, Srivastava S, Kohli GS. Intractable psychogenic sneezing: Two case reports. Indian Pediatr 2004; 41: 503-505.

2. Wyllie R. Recurrent Abdominal pain of childhood. In: Behnnan RE. Kliegman RM, Jenso HB, editors. 17th edn. Nelson Textbook of Pediatrics. Reed Elseiver India Pvt Ltd: 2004; p 1821- 1822.

3. Ohta T, Shinelo T, Kojima K. Irritable bowl syndrome in children. Nippon Rinsho, 1992; 50: 2728 (Absiract available from: URL: http: //www.pubmed.com/). Accessed May 24, 2004.

4. Sperling M. Psychogenic diarrhea and phobia in a 6½-year–old girl; workshop, 1952. Am J Orthopsychiatry 1952; 22: 838-848.

 

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